Bethesda, MD -- Like the United States, China is grappling with a serious obesity epidemic, with more than 25 percent of its adults considered overweight or obese and the rate of overweight adults in the country growing remarkably fast, reports a new study in the journal Health Affairs. Movement toward a Western diet and declining physical activity are helping drive up obesity and overweight rates among the Chinese, a pattern that researchers predict will double by 2028 without efforts to address the problem. http://content.healthaffairs.org/cgi/content/abstract/27/4/1064

The study is one of several in the July/August thematic issue on China and India that focuses on the effects of economic growth and development on public health. The issue is published with support from the Bill & Melinda Gates Foundation. http://content.healthaffairs.org/current.shtml

“What’s happening in China should be seen as a marker for what is going to hit the rest of the developing world if we fail to act,” said study author Barry Popkin, a professor of nutrition at the Carolina Population Center at the University of North Carolina. “We need to find the right investments and regulations to encourage people to adopt a healthy lifestyle, or we risk facing higher rates of death, disease, and disability and the related costs,” he added.

The rate of increase in becoming overweight among adults in China is greater than in all developing countries except Mexico, and greater than that among developed nations such as Australia, the United Kingdom, and the United States. The rate of change in overweight status among Chinese is far larger than in the United States, where two-thirds of adults are considered overweight or obese. Using national data from the China Health and Nutrition Survey, Popkin found that a little more than 1.2 percent of Chinese adult males became obese or overweight each year in the past decade, whereas the annual rate of increase was slightly less among adult men in Australia, the United States, and the United Kingdom.

With obesity comes a host of other health problems. China is experiencing a large increase in nutrition-related causes of death, including coronary heart disease, and cancer. Since 1985, deaths from diseases linked to poor diets have increased from 48 percent to 61.8 percent in urban areas and from 34.5 percent to almost 46 percent in rural areas. The loss in productivity and increased medical costs represents about 4-8 percent of the gross domestic product (GDP).

The explosion in obesity rates in China is attributable to increased use of edible oil in the Chinese diet and to greater consumption of animal-source foods such as eggs, poultry, beef, and pork. Eating patterns have changed and do not include as many vegetables and carbohydrates as were once found in the classic Chinese diet. In addition, China is experiencing the world’s fastest growth in supermarkets, which are spreading to cities and higher-income rural areas. These allow easier access to cheap processed and energy-dense foods.

At the same time, the Chinese are moving away from physically demanding occupations such as farming in favor of more sedentary service-sector jobs, which require less physical activity during the day. Other major changes in physical activity are linked to more reliance on cars and more time in front of the television. In China, 14 percent of households bought a car between 1989 and 1997. The odds of being obese are 80 percent higher for men and women in households that own a car than for those in households that do not, according to Popkin. In addition, television ownership has skyrocketed. In 1989, only 63 percent of households owned a television set, but today nearly all households do.

Popkin says that much like the United States, the Chinese government needs to step up efforts to encourage its citizens to eat more fruit, vegetables, and high-fiber food such as soybeans, and to reduce the intake of fat and caloric sweeteners, and needs to create environments that stimulate more physical activity.

“A few countries are already beginning to take some steps to address these issues, but much remains to be done,” Popkin concludes.

What’s In The Issue? The July/August issue of Health Affairs focuses on a range of health issues in China and India. Highlights include:

Aging In China And India. As home to the world’s largest populations, China and India are facing similar challenges trying to cope with issues related to aging. The World Health Organization’s Somnath Chatterji and colleagues compared health status, risk factors, and chronic diseases among people age 45 and older in China and India. By 2030, older adults are projected to account for two-thirds of the total disease burden in China and almost half of the disease burden in India. http://content.healthaffairs.org/cgi/content/abstract/27/4/1052

Smoking and diseases related to smoking are a major challenge. Researchers found that smoking was common among older adults in both countries, especially among the poor and particularly among men. Almost 48 percent of men in China and a little over 39 percent of men in India are daily smokers. Encouraging more physical activity is another challenge. Ten percent of Chinese and 17.7 percent of Indians surveyed say they are not physically active, which could spur more chronic illnesses. Researchers estimate that death from chronic disease in China will increase 200 percent during 2000-2040. Chronic diseases such as diabetes will only grow as a result of a social and economic development. The number of people with diabetes in China is expected to increase from 20.8 million people to 42.3 million people between 2000 and 2030. In India, that number is expected to increase from 31.7 million to 79.4 million during the same period.

These findings have major implications for health policy in both countries, according to the researchers. Health care and social service systems will need to make adjustments to respond to the aging population, they conclude.

HIV/AIDS In India. India’s $2.5 billion, five-year plan to fight HIV/AIDS holds valuable lessons for other countries, say authors Mariam Claeson of the World Bank and Ashok Alexander of Avahan, the Bill & Melinda Gates Foundation’s India AIDS Initiative. India has earmarked almost 70 percent of this budget for prevention, with one-third dedicated to prevention activities for those at highest risk of HIV infection and the remainder to expand HIV testing and other services for pregnant women. About 20 percent to the total budget for fighting HIV/AIDS will go toward care and treatment. http://content.healthaffairs.org/cgi/content/abstract/27/4/1091

Successful HIV prevention programs have had several characteristics in common. Some of the keys to success include high-level political commitment; investment in evidence-based, targeted interventions such as promotion of condom use, peer education, or needle exchange programs; good monitoring and evaluation of such programs; a focus on providing services to the vast majority of those at risk; and adequate technical, human, and financial resources.

“Globally, we have solid evidence for what works in addressing concentrated epidemics through large-scale programs, focusing on vulnerable communities at highest risk,” they write. “The challenge today is scaling up proven interventions to provide services to the vast majority of populations at risk. In most countries in Asia, this will require expanding programs in both geographic reach and populations served, monitoring the quality and use of services, and measuring the impact on behavioral change.”

Specialty Care And Developing Countries. Aman Bhandari and colleagues describe how a specialty care network in India could serve as a model for delivering care in developing countries. The Aravind Eye Care System, which won this year’s Gates Foundation Award for Global Health, provides surgical care to the poor to eradicate cataract blindness. Aravind is a mission-driven organization that strongly emphasizes standardization and continuous improvement. Other keys to success are the ability to attract and train a specialized workforce; access low-cost technologies; and build volume by successfully partnering with local organizations to conduct extensive community outreach programs. http://content.healthaffairs.org/cgi/content/abstract/27/4/964

Between 1997 and early 2008, 231 eye hospitals in India and other countries have worked with Aravind to adopt elements of its system for care. The authors write that Aravind’s approach “may hold great relevance for the future of health care delivery in the developing world. By developing a core competency -- expanding access in a focused area of care -- organizations in developing countries can marshal needed resources.”

Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. Web Exclusives are supported in part by a grant from the Commonwealth Fund.